Fish Farm Proposal Form (Marine & Freshwater Sites)

Transcription

1 Fish Farm Proposal Form (Marine & Freshwater Sites)

2 1. PROPOSER S NAME: CONTACT NAME: POSITION WITHIN COMPANY: MAILING ADDRESS: POSTCODE: TEL NO: FAX NO: MOBILE NO: SITE NAME: SITE ADDRESS: SITE LOCATION (Latitude and Longitude) : POST CODE: SITE LICENCE NO: TEL NO.: FAX. NO.: SITE MANAGEMENT PERSONNEL FIRST NAME SURNAME DATE OF BIRTH POSITION Manager Ass. Manager QUALIFICATIONS NUMBER OF YEARS EXPERIENCE NUMBER OF YEARS AT THIS SITE MOBILE NO: TOTAL NUMBER OF PRODUCTION PERSONNEL FOR OFFICE USE ONLY OBSERVATIONS RECEIVED REVIEWED INITIATED

3 DATE SITE FIRST ESTABLISHED AND BY WHOM: DATE SITE COMMENCED OPERATION UNDER PRESENT OWNERSHIP: GIVE NAME & PROXIMITY OF ANY OTHER FISH FARM WITHIN 5 MILES OF YOUR SITE: IS THIS SITE SUBJECT TO AN AREA MANAGEMENT AGREEMENT: DETAIL ANY KNOWN OR POTENTIAL SOURCES OF RISK E.G. POLLUTION, BLOOM, DISEASE ETC. AT ANY LOCATION WITHIN 5 MILES OF YOUR SITE: WATER PARAMETERS WATER TEMPERATURE MIN:0 MAX:01 D.O. LEVELS MIN: MAX: ph LEVELS MIN: MAX: SALINITY MIN: MAX: WATER CURRENT IN AREA: MAXIMUM SPEED IN KNOTS DIRECTION North MAXIMUM FETCH/EXPOSURE: MAXIMUM WAVE HEIGHT: MAXIMUM WIND SPEED: NORMAL MINIMUM WATER DEPTH AT SITE: TIDAL VARIANCE OF WATER DEPTH AT SITE: WATER MONITORING: IN MILES IN METRES IN MPH IN METRES MIN IN METRES MAX IN METRES FREQUENCY METHOD STATE ANY WATER QUALITY PROBLEMS PAST & PRESENT: EXPOSURE TO ICE:

4 2. STOCK CURRENT SPECIES DATE OF TRANSFER NUMBER AT TRANSFER WEIGHT AT TRANSFER MAX/MIN SUPPLIER PROJECTED MORTALITY TO HARVEST PROJECTED HARVEST WEIGHT PROJECTED HARVEST DATE STOCK FUTURE (WITHIN THE NEXT 12 MONTHS) SPECIES DATE OF TRANSFER NUMBER AT TRANSFER WEIGHT AT TRANSFER MAX/MIN SUPPLIER PROJECTED MORTALITY TO HARVEST PROJECTED HARVEST WEIGHT PROJECTED HARVEST DATE OVERALL MAXIMUM STOCK VALUE: CURRENCY COVER REQUIRED: AMOUNT EQUIPMENT: TYPE: CAGES, FEED BARGE/ SYSTEM ETC SIZE MANUFACTURER YR OF MANUFACTURE MATERIAL NUMBER VALUE COVER REQUIRED: NETS TYPE DEPTH MANUFACTURER YR OF MANUFACTURE MESH SIZE e.g. 18mm TWINE SPEC e.g. Denier / Ply NUMBER TAGGED YES / NO VALUE COVER REQUIRED:

5 PREDATOR EXCLUSION PREDATOR NETS (SEAL, BIRD etc) TYPE AGE (YR) MANNER OF INSTALLATION VALUE COVER REQUIRED: MOORINGS & ANCHORING SYSTEM CONCRETE BLOCKS ANCHORS CAGES OTHER e.g Rock Pins VALUE Incl; Anchors, Ropes etc. BARGES FEEDING SYSTEMS OTHER DESIGNED / SPECIFIED BY CAGE MANUFACTURER? IF NOT WHO DESIGNED / SPECIFIED NAME QUALIFICATIONS EXPERIENCE CAGES INSTALLED BY WHOM? NAME QUALIFICATIONS EXPERIENCE SPARE MOORING AVAILABLE ON SITE COVER REQUIRED: BOATS TYPE YEAR BUILT LENGTH TONNAGE CONSTRUCTION VALUE EXCLUDING ENGINE IF OUTBOARD OUTBOARD MAKE YEAR OF MANUFACTURE VALUE OF OUTBOARD COVER REQUIRED:

6 SPECIFY THE MAXIMUM WIND STRENGTH & FETCH USING COMPASS ROSE North WIND MPH North West FETCH MILES North East WIND MPH WIND MPH West FETCH MILES FETCH MILES East WIND MPH WIND MPH FETCH MILES FETCH MILES South West South East WIND MPH WIND MPH FETCH MILES South FETCH MILES WIND FETCH MPH MILES SPECIFY THE LAYOUT OF THE MOORINGS IN THE DIAGRAM BELOW CAGES WATER SURFACE Shackle, Hard Eyes CONNECTION (Manufacturer & Specification) Chain, poly prop, poly steel etc BRIDLE (Length & Specification) Through bar, safety chain etc CUSHION FLOAT (Manufacturer & Specification) Shackle, hard eyes, mousing etc CONNECTION (Manufacturer & Specification) Karak Ropes, poly steel etc SCOPE ROPE (Length & Specification) WATER DEPTH Shackle, hard eyes, mousing etc CONNECTION (Manufacturer & Specification) Stud Link, plain link, long link GROUND CHAIN (Manufacturer & Specification) Shackle, hard eyes, mousing etc CONNECTION (Manufacturer & Specification) Samson, Plough, Block / Rock pin ANCHORS (Manufacturer & Specification) SEA BED Rock, Silt, Sand etc. DESCRIPTION OF SEA BED

7 PROVIDE A DIAGRAM OF THE SITE USING THIS SHEET

8 3. EQUIPMENT CARE & STOCK CONTROL FREQUENCY AND EXTENT OF MAINTENANCE CAGES DAILY WEEKLY MONTHLY ANNUALLY BY WHOM: NAME QUALIFICATIONS EXPERIENCE NETS DAILY WEEKLY MONTHLY ANNUALLY BY WHOM: NAME QUALIFICATIONS EXPERIENCE MOORINGS DAILY WEEKLY MONTHLY ANNUALLY BY WHOM: NAME QUALIFICATIONS EXPERIENCE NET STORAGE:- UNDERCOVER SCHEDULE OF NET CHANGES: SHADE NETTING DETAILS: NONE PARTIAL COVER COMPLETE COVER METHOD FOR MORTALITY REMOVAL (OTHER THAN DIVING AS NOTED BELOW) MAXIMUM STOCKING DENSITY: Kg/m2 or Kg/m3 WHEN THIS OCCURS: DIVE REPORTS RECORDED: YES NO FREQUENCY OF SITE DIVES SUMMER: WINTER: PURPOSE OF DIVES: MORT REMOVALS MOORINGS INSPECTION NET INSPECTION CAGE COLLAR INSPECTION STOCK HEALTH RECORD (DETAIL ANY PROBLEMS DURING THE LAST 5 YEARS) CAUSATIVE AGENT DATE TREATMENT FREQUENCY OUTCOME

9 DETAIL DISEASE MONITORING & LABORATORY FACILITIES:- ON SITE: OFF SITE: VETERINARIAN USED: NAME TELEPHONE NO.: FREQUENCY OF HEALTH CHECKS: BY WHOM NAME QUALIFICATIONS EXPERIENCE FALLOWING PRACTISED: PERIOD DURATION SECURITY GENERAL ALARMS GUARD PATROL IF YES 24 HOURS ELECTRONIC/MECHANICAL PREDATOR SCARERS NUMBER OF UNITS AGE OF UNITS RECOMMENDED COVERAGE UTILISATION/DISTRIBUTION SYSTEM MAINTENANCE SCHEDULE MANUFACTURER POWER SOURCE AREA OF SITE EMERGENCY AVAILABILITY OF STAFF ON SITE PROXIMITY TO SITE: IS THE SITE EXPOSED TO ANY OF THE FOLLOWING PARTICULAR RISKS: YES/NO IF YES STATE PREVENTATIVE/REMEDIAL MEASURES STORM TSUNAMI DISEASE JELLYFISH BLOOMS (ALGAL,PLANKTON) POLLUTION PREDATION SALINITY FLUCTUATION WATER QUALITY DEBRIS EXPOSURE SHIPPING/BOATING OTHER (DETAILS)

10 4. PREVIOUS LOSS HISTORY DURING THE LAST 10 YEARS (WHETHER OR NOT THE SUBJECT OF A CLAIM) STOCK DATE CAUSE OF LOSS EQUIPMENT / BOATS SPECIES NUMBER AVERAGE WEIGHT GROSS LOSS NETT SETTLEMENT DATE CAUSE OF LOSS VALUE TYPE: CAGE/BOAT etc GROSS LOSS NETT SETTLEMENT NAME OF PRESENT INSURERS: RENEWAL DATE: NAME OF ANY PREVIOUS INSURER:

11 IN RESPECT OF THE PROPERTY, THE SUBJECT OF THIS PROPOSAL, HAS ANY INSURER: (A) (B) (C) DECLINED: CANCELLED COVER: IMPOSED RESTRICTED TERMS OR ADDITIONAL PREMIUMS: IF YES, PROVIDE DETAILS: PLEASE PROVIDE ANY OTHER INFORMATION WHICH YOU FEEL MAY BE RELEVANT: SIGNING THIS FORM DOES NOT BIND THE PROVIDER OR INSURER TO COMPLETE THE INSURANCE, BUT IT IS AGREED THAT THIS PROPOSAL SHALL BE THE BASIS OF THE INSURANCE CONTRACT ENTERED INTO WITH THE COMPANY. I HEREBY DECLARE THAT THE PARTICULARS AND ANSWERS GIVEN IN THIS PROPOSAL ARE IN EVERY RESPECT TRUE AND CORRECT AND THAT I HAVE NOT WITHHELD ANY INFORMATION CALCULATED TO INFLUENCE THE DECISION OF THE COMPANY IN REGARD TO THE UNDERWRITING OF THE RISKS TO WHICH THIS PROPOSAL RELATES. FAILURE TO DISCLOSE ALL RELEVANT FACTS MAY INVALIDATE YOUR POLICY. INSURERS SHOULD IMMEDIATELY BE ADVISED OF ALL MATERIAL CHANGES OR ALTERATIONS OF THE INFORMATION PROVIDED IN THIS PROPOSAL. A MATERIAL CHANGE IS ONE WHICH WOULD INFLUENCE THE JUDGEMENT OF A PRUDENT INSURER IN SETTING THE TERMS OR PREMIUMS OR DETERMINING WHETHER TO CONTINUE ACCEPTANCE OF THE RISK. SIGNATURE: PRINT NAME: COMPANY: COMPANY ADDRESS: DATE: POSITION:

12 HOW WE USE YOUR DATA BY SIGNING THIS FORM YOU CONSENT TO US PROCESSING ANY PERSONAL DATA YOU DISCLOSE TO US (INCLUDING SENSITIVE PERSONAL DATA) WITHIN THE MEANING OF THE UK DATA PROTECTION ACT WE USE THIS INFORMATION, AND ANY ADDITIONAL INFORMATION WE SUBSEQUENTLY COLLECT FROM YOU IN CONNECTION WITH OUR INSURANCE POLICIES, TO:- i. ASSESS YOUR SUITABILITY FOR AN INSURANCE POLICY; ii. PROVIDE YOU WITH INSURANCE COVER; iii. ISSUE STATUTORY NOTICES, CIRCULARS AND CORPORATE DATA; iv. RENEW OR AMEND YOUR INSURANCE POLICY; v. RESPOND TO ANY CLAIM(S) YOU MAY MAKE; vi. ASSESS FUTURE PROPOSALS FOR INSURANCE; vii. MAKE PAYMENTS IN RESPECT OF CLAIMS UNDER YOUR POLICY ACCEPTED BY US; viii. CONTACT YOU WITH INFORMATION ABOUT OUR COMPANY AND OUR PRODUCTS; AND ix. COMPLY WITH OUR LEGAL Sunderland OBLIGATIONS. Marine Insurance Company Limited Registered Office: Salvus House, Aykley Heads, Durham, DH1 5TS, UK FAILURE TO PROVIDE THIS INFORMATION Tel: +44 (0)191 MAY AFFECT YOUR Fax: ABILITY + 44 (0)191 TO ENTER 374 INTO, 0484 OR CLAIM UNDER, AN INSURANCE POLICY WITH US. TO ENABLE US TO PAY CLAIMS THAT WE HAVE ACCEPTED, WE MAY NEED TO COLLECT BANK DETAILS FROM YOU. FROM TIME TO TIME WE MAY RETAIN THESE DETAILS SECURELY TO ENABLE US TO PROCESS FUTURE CLAIM PAYMENTS. IF YOU WOULD PREFER US NOT TO RETAIN THIS INFORMATION, PLEASE LET US KNOW. DISCLOSURE OF YOUR PERSONAL INFORMATION BY SIGNING THIS FORM YOU AGREE THAT WE MAY DISCLOSE PERSONAL DATA WE HAVE COLLECTED, OR MAY COLLECT, FROM YOU TO:- i. OTHER (RE)INSURERS; ii. ORGANISATIONS WITHIN THE SUNDERLAND MARINE GROUP (INCLUDING GROUP ENTITIES OUTSIDE THE UK IN COMPLIANCE WITH ALL APPLICABLE DATA PROTECTION LEGISLATION); iii. SURVEYORS, LOSS ADJUSTERS AND OTHER INVESTIGATORS; iv. PROFESSIONAL ADVISORS; v. FINANCIAL AND/OR REGULATORY INSTITUTIONS; vi. ORGANISATIONS THAT PROVIDE SERVICES TO US IN RELATION TO OUR PRODUCTS; AND vii. LAW ENFORCEMENT AGENCIES. THIRD PARTY INFORMATION BY SIGNING THIS FORM YOU CONFIRM THAT YOU HAVE OBTAINED ALL RELEVANT CONSENTS FROM ALL INDIVIDUALS WHOSE DATA YOU DISCLOSE IN THIS FORM (INCLUDING BUT NOT LIMITED TO CREW, SKIPPERS, EMPLOYEES AND OWNERS). IF YOU REQUIRE ANY FURTHER INFORMATION ABOUT OUR DATA PROTECTION POLICY PLEASE CONTACT OUR COMPANY SECRETARY (+44(0) ; info@sunderlandmarine.com).